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CT Anatomy and Pathology of the Urinary System, Adrenal Glands and Prostate.

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CT Anatomy and Pathology of the Urinary System, Adrenal Glands and Prostate.

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    1. CT Anatomy and Pathology of the Urinary System, Adrenal Glands and Prostate.

    2. First, some basic CT Principles you will need for this learning module.

    3. View the image is as if you were looking up from the patient’s feet.

    4. CT Basics

    5. ADRENAL GLANDS

    6. Adrenal glands They look like a “V” or a “Y” on CT. The Right Adrenal Gland is behind the IVC and medial to the liver. The Left Adrenal is lateral to the Aorta or Left Crus and posterior to the splenic vessels.

    7. One more look without the arrows…

    8. Kidneys

    10. The Right Kidney comes into view a little more inferiorly…

    11. Following the vasculature down…

    12. Following the vasculature down…

    13. Following the vasculature down…

    14. Following the vasculature down…

    15. Fascial Compartments

    16. Time out for a brief technical point…

    17. Phases of IV Contrast Depending on the timing, different structures are enhanced by IV contrast. Pre-contrast Phase = Non-contrast – no enhancement. Arterial Phase (15-25 seconds) Angionephric or Venous Phase (30-60 seconds) The Renal cortex appears enhanced. Nephrographic Phase (75-100 seconds) Cortex and Medulla appear enhanced. Excretory/Urographic Phase (after 3 minutes -- routinely taken at 10 minutes) The collecting system is enhanced.

    18. OK, now back to Anatomy…

    19. Anatomy of the Collecting System

    20. Post Contrast Image (Remember, it helps to visualize the Urinary Collecting System.)

    21. Structures related to the ureters

    22. Follow the Ureters Down along the Psoas Muscle

    23. After crossing over the branch point of the Iliacs, the ureters move along the lateral pelvic wall within the ureteric fold…

    24. On their way to the bladder…

    25. Finally the ureters enter the bladder posterolaterally.

    26. What gender is this patient?

    27. Search Pattern Adrenal Glands – limbs = 1 cm thick, uniform, homogenous, and without convexities. Kidneys – without enlargement, atrophy, distortion, striation, cysts or masses. Fascial Compartments – without swelling, fluid, air or fat stranding Pelvises and ureters – without dilation or obstruction. Bladder – distension, wall thickness and contents in the lumen. Prostate – without enlargement or nodules

    28. Urinary CT Pathology

    29. What is this?

    30. What is the abnormality?

    31. Pelvic Symphysis Diastasis

    32. Does this person have 2 Gall Bladders?

    33. Hmmmm… that looks big.

    34. What structure is involved?

    36. Simple Renal Cyst

    38. Transitional Cell Carcinoma

    39. Time out for a brief technical point…

    40. CT Basics Artifacts: things that mess up your image. Patient Motion Volume Averaging – the computer averages the density of a cubic unit called a “voxel,” and attributes a brightness to it. So depending on what is around the structure of interest it can appear more or less dense on CT. Beam Hardening – “streaks” appear because low energy photons are absorbed by high density material (metal, bone, etc.).

    41. OK, now back to cases…

    42. Where is the abnormality?

    43. Do you see any “beam hardening”?

    44. Prostate Cancer

    45. Do you see an abnormality?

    46. Can you identify the abnormality now?

    47. If you’re not sure just magnify the area of interest.

    48. Is this lesion enhancing or non-enhancing?

    49. Renal Cell Carcinoma (RCC)

    50. Where is the abnormality?

    51. What density is this lesion?

    52. Adrenal Adenoma Another common, benign, asymptomatic “incidentaloma.” No history of cancer or Sx suggesting functional adrenal tumor (HTN, etc.) supports the diagnosis Low attenuation is due to the cholesterol content used for making adrenocorticoid hormones. Fat does not take up contrast well, so it does not enhance well and it washes out quickly.

    53. What is abnormal on this slide?

    54. So what is this hyperintense opacity?

    55. What is your differential?

    56. How could you tell if there is an obstruction?

    57. Do you see any evidence of obstruction?

    58. Kidney Stones

    59. That’s enough for now!

    60. Get on PACS and look at CTs and get comfortable using the software. Then read the reports to compare what you found. Try these web sites for more anatomy and cases: http://www.learningradiology.com http://uuhsc.utah.edu/rad/medstud/Abdomen.htm For Further Practice

    61. References Kocakoc, E et al. “Renal Multidector Row CT.” Radiol Clin N Am 43 (2005) 1021 – 1047 Strang JG et al. Body CT secrets. Philadelphia, PA : Mosby Elsevier, 2007. Webb, WR, et al. Fundamentals of body CT 3rd ed. Philadelphia : Elsevier/Saunders, 2006. Uzelac, A et al. Blueprints Radiology, 2nd Ed. Baltimore: Lippencott, Williams and Wilkens, 2006 CT images were obtained from OHSU PACS with findings reported by OHSU faculty.

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